Clinical Review ABC of psychological medicine

Musculoskeletal pain

BMJ 2002; 325 doi: (Published 07 September 2002) Cite this as: BMJ 2002;325:534
  1. Chris J Main,
  2. Amanda C de C Williams

    Musculoskeletal symptoms of various types (neck pain, limb pain, low back pain, joint pain, chronic widespread pain) are a major reason for consultation in primary care. This article uses the example of low back pain because it is particularly common and there is a substantial evidence base for its management. The principles of management outlined are also applicable to non-specific musculoskeletal

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    The increasing prevalence of musculoskeletal pain, including back pain, has been described as an epidemic. Pain complaints are usually self limiting, but if they become chronic the consequences are serious. These include the distress of patients and their families and consequences for employers in terms of sickness absence and for society as a whole in terms of welfare benefits and lost productivity. Many causes for musculoskeletal pain have been identified. Psychological and social factors have been shown to play a major role in exacerbating the biological substrate of pain by influencing pain perception and the development of chronic disability. This new understanding has led to a “biopsychosocial” model of back pain.

    Biopsychosocial model of the clinical presentation and assessment of low back pain and disability at a point in time

    Research has also shown that there are many different reasons for patients to consult their doctor with pain—seeking cure or symptomatic relief, diagnostic clarification, reassurance, “legitimisation” of symptoms, or medical certification for work absence or to express distress, frustration, or anger. Doctors need to clarify which of these reasons apply to an individual and to respond appropriately.

    Managing acute back pain

    Most patients can be effectively managed with a combination of brief assessment and giving information, advice, analgesia, and appropriate reassurance. Minimal rest and an early return to work should be encouraged. Explanation and advice can be usefully supplemented with written material.

    Doctors' tasks include not only the traditional provision of diagnosis, investigation, …

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